Relationships between obesity, glycemic control, and cardiovascular risk factors: a pooled analysis of cross-sectional data from Spanish patients with type 2 diabetes in the preinsulin stage

Abstract

BackgroundObesity is associated with the onset of type 2 diabetes mellitus (T2D), but reports conflict regarding the association between obesity and macrovascular complications. In this study, we investigated associations between cardiovascular risk factors and body mass index (BMI) and glycemic control in non–insulin-treated patients with T2D.MethodsAuthors gathered cross-sectional data from five observational studies performed in Spain. Generalized logit models were used to analyze the relationship between cardiovascular risk factors (independent variables) and 5 BMI strata (<25 kg/m2, 25 to <30 kg/m2, 30 to <35 kg/m2, 35 to <40 kg/m2, ≥40 kg/m2) and 5 glycated hemoglobin (HbA1c) strata (≤6.5%, >6.5–7%, >7–8%, >8–9%, >9%) (dependent outcomes).ResultsIn total, data from 6442 patients were analyzed. Patients generally had mean values of investigated cardiovascular risk factors outside recommended thresholds. Younger patients had higher BMI, triglyceride levels and HbA1c than their older counterparts. Diastolic blood pressure, systolic blood pressure and triglyceride levels were directly correlated with BMI strata, whereas an inverse correlation was observed between BMI strata and high-density lipoprotein cholesterol (HDL-C) levels, patient age, and duration of T2D. Increased duration of T2D and total cholesterol levels, and decreased HDL-C levels were associated with a higher HbA1c category. BMI and HbA1c levels were not associated with each other.ConclusionsAs insulin-naïve patients with T2D became more obese, cardiovascular risk factors became more pronounced. Higher BMI was associated with younger age and shorter duration of T2D, consistent with the notion that obesity at an early age may be key to the current T2D epidemic. Glycemic control was independent of BMI but associated with abnormal lipid levels. Further efforts should be done to improve modifiable cardiovascular risk factors.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2261-14-153) contains supplementary material, which is available to authorized users.

Twelve-year trends of increasing overweight and obesity in patients with diabetes: the Shiga Diabetes Clinical Survey

“…BMI was inversely related to age in this study. This relationship between BMI and age is consistent with previous studies, which also demonstrated an inverse association with duration of diabetes [6,21]. Japanese patients with diabetes have quite limited insulin secretory capacity and are becoming obese during the early stages of the disease [22].…”

Disease progression in newly diagnosed Type 2 Diabetes Mellitus patients: a statistical analysis using Clinical Practice Research Datalink (CPRD)

“…It has also been suggested that an adverse metabolic profile in patients with normal weight increases the risk of subsequent development of T2DM and other CVD 65,66,68 . A recent study explored the relationship between obesity, glycaemic control and cardiovascular risk factors in T2DM patients who were not receiving insulin treatment and concluded that cardiovascular risk factors become more important as patients became more obese 65 .…”

“…It has also been suggested that an adverse metabolic profile in patients with normal weight increases the risk of subsequent development of T2DM and other CVD 65,66,68 . A recent study explored the relationship between obesity, glycaemic control and cardiovascular risk factors in T2DM patients who were not receiving insulin treatment and concluded that cardiovascular risk factors become more important as patients became more obese 65 . This study also reported that younger age and more recent onset of the disease were associated with higher BMIs, suggesting that the development of an obese condition at an early age could be a significant factor underlying the increase in T2DM incidence 65 .…”

“…A recent study explored the relationship between obesity, glycaemic control and cardiovascular risk factors in T2DM patients who were not receiving insulin treatment and concluded that cardiovascular risk factors become more important as patients became more obese 65 . This study also reported that younger age and more recent onset of the disease were associated with higher BMIs, suggesting that the development of an obese condition at an early age could be a significant factor underlying the increase in T2DM incidence 65 . Further, studies have reported that individuals of normal weight have a substantial risk of developing T2DM and CVD 66,68 .…”

“…It has been shown that obesity plays a major role in the pathophysiology of T2DM and its macrovascular complications [65][66][67] . It has also been suggested that an adverse metabolic profile in patients with normal weight increases the risk of subsequent development of T2DM and other CVD 65,66,68 .…”